Heart Care FAQs

Coronary artery disease is caused by hardening of the arteries, or atherosclerosis. Atherosclerosis occurs when plaque builds up inside the arteries. (Arteries are the blood vessels that carry oxygen-rich blood throughout your body.) Atherosclerosis can affect any arteries in the body. When it occurs in the arteries that supply blood to the heart, it is called coronary artery disease. CAD is the number one killer of both men and women in the United States.

Usually people with coronary artery disease don't have symptoms until after age 50. Then they may start to have symptoms at times when the heart is working harder and needs more oxygen, such as during exercise. The severity of these symptoms varies. The symptoms may get more severe as the buildup of plaque continues to narrow the coronary arteries. Typical first symptoms include:

• Chest pain, called angina, may feel like pressure or squeezing pain in your chest. You may also feel it in your shoulders, arms, neck, jaw or back. The pain tends to get worse with activity and go away when you rest. Emotional stress can also trigger this pain.

• Shortness of breath may occur with heart failure, as your heart can't pump enough blood throughout your body. Fluid builds up in your lungs, making it hard to breathe.

• Heart attack is often the first symptom of CAD.

Coronary arteries are blood vessels that feed oxygen-rich blood to your heart muscle. Having an adequate supply of blood is important because, like the rest of your body, the heart muscle needs oxygen to stay healthy. With every breath you take, blood absorbs oxygen from the lungs and then the heart pumps the oxygen-rich blood throughout the body. The heart pumps some of that oxygen-rich blood through the coronary arteries back to its own muscle.

The risk factors that play a role in coronary artery disease can be split into two categories: those you can change and those you can’t. Risk factors that you can't change include:

• Family history — You're more at risk if one or more of your close relatives have or had early CAD.
  
  
• Gender — Men generally develop heart disease 10 years earlier than women. But women who have diabetes may develop heart disease at a younger age. By age 60, heart disease is one of the leading causes of death in both sexes.
  
  
• Age — People over 65 are more likely to have heart disease. Gender, age and family history are factors over which you have no control, but you can mitigate against them with health lifestyle choices.

Risk factors you can change include:

• Smoking — If you smoke, stop
  
  
• High blood pressure — There are things you can do, and medications you can take to decrease this silent threat to your heart health.
  
  
• High cholesterol — Your physician can recommend lifestyle changes you can implement to improve your good cholesterol and lower the bad.
  
  
• Diabetes — Over time, this condition can accelerate hardening and narrowing of the coronary arteries, resulting in poor blood flow to the heart muscle. People who have diabetes tend to develop atherosclerosis more frequently and at a younger age than those not affected by the disease. Diabetes may double the risk of death from coronary artery disease.
  
  
• Obesity — There is a strong association between being overweight and the risk of developing coronary artery disease (CAD). The exact risk is still a matter of some debate, but it is known that being very overweight (obese) increases your chances of developing high blood pressure, diabetes, and high cholesterol, all major risk factors for CAD. Adopting a healthy diet and regular exercise can help not only your heart, but your overall health as well.
  
  
• Lack of exercise — Even if weight isn’t an issue, exercise is important for strong muscles, including the heart
  
  
• Birth control pills — Be sure your physician knows if you are using the pill.

Regular checkups with your doctor, keeping tabs on your “numbers” (cholesterol and blood pressure) will help ensure that your doctor catches any indication of heart trouble early. At that point your physician may order further tests, such as a sonogram of the carotid artery to see if there is build up of plaque on the artery walls that could cause problems down the road.

Many people with heart disease can be treated by lifestyle changes and medicine or angioplasty. But sometimes coronary artery bypass graft surgery is needed. It uses healthy blood vessels to create detours around narrowed or blocked arteries. Traditional bypass surgery is an open-chest procedure. For some patients, minimally invasive or robot-assisted surgery is an option, offering less pain, faster recovery and no cracked chest.

At the Louis & Peaches Owen Heart Hospital, our cardiothoracic surgeons are leaders in minimally invasive techniques, including robot-assisted bypass surgery using the daVinci Robotic Surgical System®.Your treatment will depend in part on:

• How many arteries are blocked
  
• How badly the arteries are blocked, and where
  
• Other heart problems you may have
  
• Your feelings about treatment

Surgery isn't right for everyone. Making lifestyle changes and taking medicine or having angioplasty carry fewer risks than surgery and can work just as well for some people. No matter what treatment you receive, you'll still need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life.

Following the diagnosis of coronary artery disease (CAD), you should visit your primary care physician every few months to track your condition and ensure that your treatment is going as planned. If you develop complications or need special procedures (such as cardiac catheterization or open-heart surgery), you may require treatment from a variety of specialists.

Depending on the severity of your CAD and whether you have already developed complications, you may need a team of health professionals to help treat your disease and manage your treatment plan.

An electrocardiogram records the electrical activity of the heart to determine if the heart is beating in a healthy pattern. It also detects if chest pain is caused by a heart attack or angina.

Coronary artery disease is not just hard on the patient, it’s also difficult for loved ones who feel helpless in the face of this illness. It is hard to see someone you love struggle to perform routine tasks. They will require a great deal of encouragement and emotional support.

There are several steps you can take to help reduce your stress level. Doing so will have a positive impact on your health and life.

No single method of "stress-busting" works for everybody. You may need to experiment with several methods to find one that works for you. You may need to combine a few methods to get the best results.

Cognitive behavioral methods can be the best way to lower stress level. Here are some suggestions:

• Identify your stress triggers and keep a journal to record them and begin to find alternatives to avoid them, if possible
  
• Recognize positive activities, like riding a bike or reading before bedtime
  
• Think of solutions to dealing with stress triggers
  
• Add stress-busting activities to your day, such as deep breathing, short walks or meditation
  
• Set aside time every day for relaxing activities, such as a family meal or joining a support group
  
• Talk about your problems and feelings with family, friends or with a professional who can help you deal with feelings of anger, depression or helplessness
  
• Exercise, which can lower stress triggers and lower blood pressure, contribute to weight loss and improve cardiovascular health
  
• Deep breathing, meditation or yoga are relaxing techniques to control breathing and the body's physical stress reaction
  
• Keep your perspective - Take a moment to think about what's bothering you and prioritize its importance
  
• Keep a sense of humor - Laughter is a great way to fight stress and depression
  
• Seek help if you are overwhelmed. Psychologist, psychiatrists and social workers are just a few people trained to help with your problems.

You can slow down or even prevent coronary artery disease by taking steps toward a healthier lifestyle. Eat right, exercise more and, if you smoke, stop.

• Quit smoking. It may be the best thing you can do to prevent heart disease. Smokers who quit cut their risk of heart disease by half after just one year. You can cut your risk even more by staying away from cigarettes for good. After 15 years of not smoking, your risk of death from heart disease is the same as if you had never smoked at all. It’s also important to avoid secondhand smoke.

• Exercise. There are lots of ways that exercise boosts your health. It can lower cholesterol and blood pressure. It can also help you reach a healthy weight. Try to exercise for at least 30 minutes on most, if not all, days of the week. Talk to your doctor before starting an exercise program.

• Eat a heart-healthy diet. The way you eat can help you control your cholesterol and blood pressure. To find out what's best to eat for a healthy heart see our guidelines for heart-healthy eating.

• Control your cholesterol and blood pressure

Doctors order heart tests for many reasons. For example, the test can find out what's causing symptoms like unexplained chest pain, shortness of breath or irregular heartbeats. Heart tests can be appropriate for a healthy person. This happens when a personal history or physical exam points to risk for a heart problem. For example, an athlete may be at risk for a heart problem associated with exercise. So a test such as an exercise electrocardiogram can be done before he or she takes part in competitive sports.

The pain of a heart attack can vary greatly. In fact, some heart attacks are never recognized (silent infarctions) because the symptoms are mild, not typical, or even absent. This is a major reason why some people don't come to the hospital when they have a heart attack. If you have angina and notice that it is happening more often or lasting longer, you should contact your doctor.

Call 911 for emergency services immediately if:

• You feel a pressure or squeezing pain in your chest. This pain may extend to your back, jaw, neck, arms or shoulders and generally gets worse with activity and goes away with rest
  
• Shortness of breath
  
• Weakness, nausea and/or dizziness

With both a heart attack and angina, part of your heart muscle is not getting enough oxygen because of reduced or blocked blood flow in your coronary arteries. With angina, the lack of oxygen is temporary, and permanent heart damage does not occur. During a heart attack, the lack of oxygen lasts longer and causes permanent heart damage.

If you have heart disease, but are not yet experiencing the symptoms, it can be hard to realize the importance of healthy living. Talk with your doctor to learn about the disease and what you can do to help manage it and prevent it from getting worse.

Making healthy lifestyle changes can delay and maybe even reverse heart disease. Quitting smoking, eating a low-fat and low-cholesterol diet and getting regular exercise are the most important steps you can take to keep your disease from getting worse.

Walking is a form of aerobic exercise and is one of the easiest ways to increase your physical activity and improve your health. Physical activity increases your heart rate, strengthens your heart and increases blood circulation through your body, bringing more oxygen and nutrients to your organs. Exercise also increases your lungs' ability to take in oxygen, lowers blood pressure, helps to reduce body fat and improves blood sugar and cholesterol levels.
When starting any exercise program, remember:

• Have a checkup before beginning any exercise program to ensure your heart can handle new activities
  
• Start out slowly at first, with a warm-up in the beginning and a faster pace in the middle, and a slow cool-down at the end
  
• Walk with friends, family or coworkers to stay motivated
  
• Set goals you can reach
  
• Use a pedometer to count your steps and wear it everyday. Aim for 2,000 more steps a day than you normally do and gradually increase your goals
  
• Try to complete 2 1/2 hours of exercise a week, ideally 30 minutes a day at least 5 days a week

Most people who have stable angina can control their chest pain by taking medicines as prescribed and nitroglycerin when needed.
Staying active is also important. But if these things don't help you manage your angina, try these tips:

• If an activity causes angina, slow it down.
  
• Ease into your day. Warm up slowly before activity.
  
• Give yourself time to rest and digest right after meals.
  
• Change the way you eat. Eat smaller meals more often during the day instead of two or three large meals.

Controlling severe angina

When angina is more severe and you are having a hard time managing it, you can:

• See if family members or hired help can assist with heavy chores such as shoveling snow or mowing lawns. If it makes sense to do so, think about moving to a different home to avoid the physical stress caused by climbing stairs or doing heavy chores.

• If your job involves heavy labor, think about changing the kind of work you do.

• Try taking nitroglycerin before you start a stressful activity that can cause angina, such as walking uphill or having sex.

• If you are not taking nitroglycerin for chest pain, ask your doctor if it could help you.

• Control your stress - Identify stress triggers and use deep breathing or meditation exercises to relieve stress, or seek professionals who can help you sort out stress and feelings

Tell your doctor right away if:

• There is a sudden change in your angina symptoms.

• You begin to get angina at unexpected times.

• You get angina when you are resting.

Treatment for coronary artery disease focuses on taking steps to manage symptoms and reduce the risk of heart attack and stroke. For example:

• If your doctor agrees, take a low-dose aspirin each day to reduce your risk of heart attack or stroke

• Medication may be prescribed for high blood pressure or high cholesterol. They can help you manage these health problems and lower your risk

• Your doctor may also suggest medicines if you often have chest pain that makes it hard to do everyday activities

• If medicines don't help your chest pain, your doctor may suggest procedures to improve blood flow to the heart

• Angioplasty, with or without stent placement, is one way to open clogged coronary arteries. Sometimes coronary artery bypass graft surgery may be needed.

When you have coronary artery disease, it is very important to exercise regularly. Even if you can only do a small amount of exercise, it is better than not doing any exercise at all. Here are some things to consider as you look into starting an exercise plan.

• Talk to your doctor about beginning an exercise program. Your doctor may do an electrocardiogram and possibly an exercise stress test to assess how much activity your heart can safely handle.

• After you start exercising, stop immediately if you experience chest pain, feel faint or lightheaded, or become extremely out of breath.

• Try to do moderate activity on most, preferably all, days of the week. Aim for a goal to exercise at least 2 1/2 hours per week.

• A complete exercise program consists of aerobic, strength training and stretching exercises.

• Set attainable goals. If you expect too much, you are likely to become discouraged and stop exercising.

Your physician must take many factors into account when determining whether to perform heart tests. For example, there are tests to find out what's causing symptoms like unexplained chest pain, shortness of breath or irregular heartbeats. Heart tests can even be appropriate for a healthy person if his personal history or physical exam points to risk for a heart problem. For example, an athlete may be at risk for a heart problem associated with exercise. So a test such as an exercise electrocardiogram can be done before he or she takes part in competitive sports.

A calcium scan, which checks for calcium build-up in the coronary arteries, can give your physician more information about your risk for heart disease. Calcium in these arteries is a sign of heart disease. A high score on a calcium scan can mean that you have a higher chance of having a heart attack than someone with a low score. A high score might prompt your physician to start or change treatment to help you avoid a heart attack. A coronary calcium scan checks for calcium build-up in the coronary arteries.

An angiogram helps your physician determine if you need treatment for coronary artery disease, and if you do, how best to treat it. The test shows if your coronary arteries are clogged, where they are clogged and to what degree they are clogged.

Your doctor may recommend an angiogram if:

• The results of a cardiac stress test suggest that you have severe heart disease

• You are having chest pain while you are at rest or during only moderate physical activity, or you are taking medications for chest pain but they do not control it

• You have another heart problem that may be caused by heart disease

If during the test the doctor sees that your arteries are badly blocked, you may need to have an angioplasty or bypass surgery right away. So before you have the test, it's a good idea to talk with your doctor about these treatments. Ask what the test might show and what your choices are in each case.

You may not need an angiogram if you can control your chest pain and other symptoms with medicines and are otherwise healthy.

There is no evidence to show that angioplasty for stable angina heart disease will help you live any longer than medical therapy. Angioplasty can get rid of chest pain if medical therapy has not stopped your pain.

This may help you have a more active life. If you choose angioplasty, you will still need to make lifestyle changes. This will give you the best chance for a longer, healthier life. Whatever your decision, here are some things to consider:

• Angioplasty carries the risk of heart attack, stroke and even death. These rarely happen, but you may not want to take even the small risk of dying from the procedure if you have an equally small risk of dying without it.

• If you decide to try medical therapy now, you can still have angioplasty later if your chest pain bothers you too much.

• The benefits of angioplasty may not last. The repaired artery can become blocked again over time and you may need another procedure.

Even though treatment focuses on helping you live longer, it may cause side effects that can greatly affect your quality of life and your ability to spend time with your family and friends. For that reason, some patients decide to stop treatment.

If you decide to stop treatment, you will receive only care that focuses on your comfort and quality of life. This is known as palliative care. If you still have personal goals that you want to pursue, you may want treatment that helps you live long enough to achieve them.

The decision to stop treatment is a personal one and doesn’t have to be made alone. You can consult with your family, doctor and spiritual counselor before making a decision. The Pastoral Care Department at the Louis & Peaches Owen Heart Hospital is always available. Our chaplain can be reached at 903-531-4567 ,or for urgent needs, please page 903-510-1759.

It’s important to remember that the decision to stop treatment that keeps you alive doesn't have to be permanent. You can always change your mind and resume treatment if your health starts to improve or you so choose.

Angioplasty is a procedure done to open a partially blocked blood vessel so that blood can flow through it more easily. It is most often done on arteries that deliver blood to the heart (coronary arteries) when they are narrowed by plaque buildup (atherosclerosis) or blood clots. Angioplasty is not surgery. It doesn't use large incisions or require anesthesia to make you sleep.

During the angioplasty procedure, a thin flexible tube (catheter) is inserted through an artery in the groin, arm or wrist and is carefully guided into the narrowed artery. At that point a small balloon at the end of the tube is inflated. The balloon may remain inflated for a short time. The pressure from the inflated balloon presses fat and calcium deposits (plaque) against the wall of the artery to improve blood flow.

After the fat and calcium buildup is compressed, a small, expandable wire-mesh tube called a stent is sometimes inserted into the artery to hold it open. The artery is less likely to get narrow again (restenosis) after angioplasty with stenting than after angioplasty alone. See a picture of angioplasty with stents.

Atherectomy involves techniques similar to those used for angioplasty. The difference is that atherectomy uses a cutting device (a blade or a whirling blade) to remove the plaque buildup from the artery wall.

Another treatment for people with long-term chest pain is enhanced external counterpulsation (EECP). Most of the time, this is done only if you are unable to have angioplasty or surgery.

No matter what treatment you receive, in order to maintain long term benefits you'll need to make changes in the way you eat and how much you exercise. These changes, along with not smoking, will give you the best chance of living a longer, healthier life.

Each individual is unique in his or her risk factors for having a heart attack. To find out where you stand take our interactive risk assessment. This interactive tool measures your chance of having a heart attack in the next 10 years. It will calculate your risk score using the values you enter. The calculation is based on information from the Framingham Heart Study. Since 1948 the Framingham Heart Study has studied the progression of heart disease and its risk factors. The data from this study has been used to make a risk assessment. This risk assessment was created by the U.S. National Cholesterol Education Program (NCEP), part of the National Institutes of Health and the U.S. Department of Health and Human Services.

Many people have trouble correctly taking their medicines for coronary artery disease. Often, they need to take several medicines at different times of the day. And some people struggle to afford the medicines. But medicines are often a key part of treatment, and people who do not take them as prescribed have an increased risk of complications and death. Here are the most commonly prescribed medications for heart patients:

• Aspirin and other anti-platelet medicines help prevent blood clots in your coronary arteries.

• Beta blockers slow your heart rate and lower your blood pressure to reduce the amount of work your heart has to do.

• Statins lower your cholesterol and may reduce your risk of a future heart attack.

• Nitrates relieve chest pain and other symptoms of angina.

• Calcium channel blockers slow your heart rate and lower your blood pressure to reduce your heart's workload. They also widen your coronary arteries and reduce angina.

• Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart.

• Angiotensin II receptor blockers (ARBs) lower your blood pressure and reduce the strain on your heart. If you cannot tolerate the side effects of ACE inhibitors, your doctor may prescribe ARBs instead.

Anticoagulants may also be used after an angioplasty, atherectomy or bypass surgery. 

Stable angina occurs at predictable times with a specific amount of exertion or activity. It is relieved by rest and may continue without much change for years. Stable angina usually is relieved by rest within 1 to 5 minutes.

Unstable angina means that blood flow has gotten worse because of increased narrowing or small blood clots that form in the coronary arteries. Unstable angina is a warning sign that a heart attack may soon occur, and immediate medical evaluation is required.

Signs of unstable angina include:

• Chest pain began within the past 2 months and has suddenly become more frequent or severe

• New chest pain occurs 3 or more times per day

• Chest pain develops after less and less exertion

• Chest pain occurs at rest (with no obvious exertion or stress); it may awaken you from sleep

• Chest pain is less responsive to nitroglycerin

Call 911 or other emergency services immediately if you have any of the following symptoms:

• Chest pain that has not gone away within 5 minutes after you have rested or taken one nitroglycerin. After calling 911, continue to stay on the phone with the emergency operator. He or she will give you further instructions.

• Chest pain or discomfort that is crushing or squeezing, feels like pressure on the chest, and lasts more than 5 minutes, especially if it occurs with any of the following symptoms:

- Sweating

- Shortness of breath

- Nausea or vomiting

- Pain that spreads from the chest to the neck, jaw or one or both shoulders or arms

- Dizziness or lightheadedness

- A fast or irregular pulse

- Signs of shock

Women are more likely to have symptoms such as shortness of breath, heartburn, nausea, jaw pain, back pain or fatigue.

After calling 911 or another emergency service, chew 1 adult-strength aspirin (325 mg) if you are not allergic to aspirin or unable to take aspirin for some other reason. By calling 911 and taking an ambulance to the hospital, you may be able to start treatment before you arrive at the hospital. If any complications occur along the way, ambulance personnel are trained to evaluate and treat them.

If an ambulance is not readily available, have someone else drive you to the emergency room. Do not drive yourself to the hospital.

If you witness a person becoming unconscious, call 911 or other emergency services and start cardiopulmonary resuscitation (CPR). The emergency operator can coach you on how to perform CPR. You should also inform your doctor if you have episodes of chest pain or discomfort and you work in a field such as a pilot or caregiver, which involves responsibility for the lives of other people.

Never wait if you have symptoms of a heart attack. Many people are unsure whether they are having a heart attack, and so they take a "wait and see" approach. Heart attack symptoms often vary. People sometimes discount their symptoms if they do not fit into the expected "extreme chest pain" scenario. Some people are embarrassed or don't want to bother others by calling for help if they think it may not be a heart attack.

Even if you're not sure it's a heart attack, you should still have it checked out. Rapid treatment can save your life.